(*Teaching rambling expatriate with kids)

health

It has been a week now since returning from my month in the States and of the myriad of wonderful conversations and experiences and reunions, one topic has stuck in my mind: health care. Maybe it is because I came back home to a letter telling me my application for a “cure” had been approved by the national health insurance. That means that I will be spending three weeks in a “cure spa” in the mountains near Salzburg exercising with trainers, getting physiotherapy, eating healthy, and learning to replace my bad old sedentary habits with better and healthier ones. And yes, the whole thing is covered. My copay comes to $9.35 per day.

There are other reasons that health care in the States has been on my mind. In conversations with friends and family, the subject came up often. A lot of us are nearing or at retirement age, slowly winding down our careers and making decisions about “the right time to go”. In the case of two couples, the husbands were working into their 70s – putting off retirement till the day their wives qualify for Medicare. Another woman wanted to stop working and had saved enough of a nest egg to do so – she just couldn’t afford the private health insurance in the interim. One woman who was basically self-insured through her own business talked about how much those costs ate into the company’s earnings. Two more women – one with a pre-existing condition and another with a special needs child – knew that losing their jobs would have more than mere ripple effects – it would mean a financially ruinous tsunami washing over them.

“People like the health insurance they get through their employers.” How many times have I heard that statement since the start of the health care debate way back in the Clinton era? 100 times? 500? 5000? And I have never understood it. I know very few people with 100% job security, so if the employer decides whether or not you continue to have a job, don’t they also decide whether or not you continue to have health insurance? Doesn’t that yoke you to your place of employment and limit your own freedom and self-determination?

The last school year was not the best for me. There were even times when I considered leaving – to the point where we had a mini family conference about it. It would have meant bridging the last two and half years of my professional life with other “unofficial” work (tutoring, translating, etc.), but what to do about health insurance was not one of the considerations. I find myself wondering now what my situation would have been, if I were on my own and in the States . . .

I decided to make myself a fictional 57 year old single woman with no dependents, living in Milwaukee and earning $50,000 a year. A nifty paycheck calculator online told me that I would end up with $3,196 a month to live on. Ouch! That seemed pretty low. I thought Americans paid a lot less in taxes, but this was only slightly more than the Austrian equivalent of this fictional woman would take home. In her case, about $700 a month would be skimmed off the top to pay for her health care and pension.

From there, I went to the Healthcare.gov website. After first figuring out what “deductibles”, “out of pocket” and “copays” meant, I entered my fictional information and clicked on “See Plans”. Of the 24 options, here were two at the opposite ends of the spectrum:

The cheapest Bronze Plan – “only” $709 a month. (Gasp!) But if I understand deductibles correctly, I would have to pay my own medical bills up to the tune of $650 a month before the insurance ever kicked in. So . . . why am I paying the additional $709??

The best of the Gold Plans. If I’m doing the Math right, I could technically afford this one with my $3200 monthly take-home pay – that is, as long as I never go to a doctor. Or take any medicine. Or own anything requiring maintenance. Or go on vacation. Or eat out.

Again. I don’t understand.

People protested last year to save this system. They camped out at congressional offices and marched on streets with signs saying “Don’t take my health care away”. They clearly supported this system in which they pay what seems like exorbitant prices to keep insurance and pharmaceutical companies profitable. I assume many of their employers have to pay such high prices too. It must make the cost of labor a burden on their bottom lines, which in turn incentivizes downsizing, relocating, outsourcing and all of the other euphemisms for “You’re fired!”

Navigating this system, making financial or life decisions based on this system, being constantly worried about losing this system . . . that all must create a great deal of stress in people. Anxiety too. Sleepless nights. Depression. All things that can lead to other, more serious illnesses . . . but never fear! The pharma industry is on it! Whatever your problem is, they’ve got a pill for that. What’s that? You don’t know what your problem is? Well, here’s an array of possibilities to choose from . . .

I only watched about three or four hours of TV during my month in the States – but that was more than enough to get a picture of what is going on. Rachel would do her 20 minute A block without interruptions, but from then on it was a constant flow of commercials broken up by sporadic 3 minute news segments. And it seemed like a third of those ads came from pharma companies. So here’s what the experience was like:

Rachel tells me about an explosion during a Russian nuclear missile test and how the radiation is spreading in my direction.

Then a nice woman in a commercial asks me if I ever feel anxious. If so, I should ask my doctor for xxxxx which, in some cases, might lead to dry mouth or mysterious sounding “sexual side effects”.

Then I see a short report about an immigration raid with desperate crying children, after which

a pharma commercial guy asks me if I am feeling sad. If so, I could try yyyyy (but I should watch out for such side effects as fever, confusion, uncontrolled muscle movement, decreased white blood cells, seizures, impaired judgment, coma, suicide or death).

The next news report is about a recent mass shooting by a white supremacist, followed by

another nice lady asking me if I am having “racing thoughts” and trouble sleeping. I should try zzzzz (but beware of tongue swelling, memory loss, and/or hallucinations). Her successor knows what I could take for my “restless leg syndrome”, but it might increase my gambling urges or make me fall asleep while driving.

In the final news report, I hear that the pwesident is leaving to go on vacation. He has done nothing in his 2½ years so far to combat the country’s widespread addiction to painkillers, but never fear,

there is now a treatment for OIC (opioid induced constipation)! Just watch out for nausea, vomiting, stomach tearing and constant pain.

I think most people -me included – have a touch of hypochondria (aka “Illness Anxiety Disorder” or IAD) in them. Who doesn’t hear of some new disorder and think briefly “Ooh! Maybe I have that!” So I wonder what the cumulative effect of all these messages must be. And then to continually hear these gruesome lists of possible side effects which often seem to end with “death”. It’s unbearable. Four or five more hours of watching this stuff and I’d have started tearing my hair out.

Which, thanks to a sign in a Chicago el train, I now know is an official thing: trichotillomania or “hair pulling disorder”.

The industry is working on a treatment for it.

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I appreciate living in a country with a social welfare economy, but that doesn’t make me a Socialist. I also don’t believe in Capitalism for Capital’s Sake. From everything I have seen, a healthcare system that is privatized and profit-driven has every inducement in the world to keep the country sick. As long as it continues on like this, there will be no cures.

Since the husband couldn’t come along on our trip to Milwaukee this year, it was up to me to get the bikes in working order for my daughters and me to use. I hauled them up from my sister’s Silence of the Lambs basement, removed the cobwebs and set to work. Tires were pumped up, brakes were checked, rust was WD40’d, chains were oiled, seats were adjusted, gears were tested. We were good to go.

Of course, one of these three bikes was my now 42 year old Takara ten-speed which I have affectionately named “The Rejuvenator”. And once again, he lived up to his name. When I got on him and started pedaling, the old magic of muscle memory kicked in immediately. He was perfection. This was how a bike was supposed to feel! I sped off into traffic like any 15 year old would, exhilarated by my newfound mobility, leaving my fifty-seven year old achy, gouty and bursitis-prone self behind in the dust.

Common sense says that a person can’t truly love an inanimate object, but I beg to differ.

On the other hand, I find myself wondering how long this magic can last. How long can those bald and ever so slightly flatulent tires hold out? His brake lines are also creaking more, the joints of his gear levers are stiffer and he is getting crankier when I shift. His handlebar tape is sagging and decomposing. His age is showing.

And what about me? A week from now, I will take him back down to the basement before leaving to go home. At our next reunion, I will be 59 and probably as good as retired. Will I still tear around town on him when I am 61? 63? 65? Will the day come when I have to give up riding ten-speeds altogether? How will this end?

I almost hope he goes before my ability to ride him does. That a tire bursts and is too expensive to replace. Or that a part rusts through that is no longer produced. That when our relationship ends, it will not be me abandoning him. It will be his last full measure of devotion.

Greetings from an Oasis of Sanity! Also known as my sister’s house. This year I flew to the States ahead of my husband and daughters so that I could spend more time with my American family. I told people that I was going earlier so that my sister could give me some intensive therapy – a small joke, but like most humor, there was a bit of truth in there. As I wrote to her before I came: “I’m doing fine and so are (nuclear family members), but it seems to me everyone else in the world is batshit crazy”. She wrote back “I feel the same way.” (By the way, “batshit crazy” is not a term I would normally use, but I have a theory about why those words popped out of my mouth . . . )

It is Day Five in the Oasis now and healing processes are well underway. It turned out that for every story I told her from the last year – work conflicts, personal crises, relationship catastrophes, etc., she had a similar story from her experience or her various circles to relate. It seemed like an abnormally large number of our people were struggling with some serious problem. We kept wondering if something was generally wrong with the world.

And of course we laid a lot of the blame on the orange Occupant and the universal malaise in the country, thanks to his incessant trolling. We wondered when he would finally hit rock bottom; we considered the possibility that there is no bottom. We differed a bit in our theories on “what is wrong with him?!” and whether or not he is getting worse. Call me naïve, but I remain hopeful. I believe the arc of his mental decline is long, but it bends towards hospice.

These discussions happened during meals and long walks, on drives and on the porch, over coffee and while crocheting my newest project. Stitch by stitch, the world came to seem more manageable. My sister watched the progress as the form took shape, as it became an animal and then a metaphor. She asked me (in a sort of hopeful voice) what I was going to do with it when I was done.

As soon as the last loose thread was weaved in, I gave it to her for keeps:

Friday. 9:15 am. I leave work early to go to my appointment with the neurologist. I’m nervous because I have no idea what to expect, having never been to this particular type of specialist before. At the moment I start the engine,

my daughter is at her school and just beginning her oral graduation exam in the subject of Sports Science. She is summoned by a teacher and has to push a button to generate two random numbers which will determine the two topics she can choose from. 4 and 8 come up, which means either “Endurance Tests” or “Sports Injuries”. She chooses the first one and then has 45 minutes to prepare –

the same amount of time I have to get to the doctor’s office.

While driving, my mind runs through the litany of tests and pricks and probes and irradiations I have gone through in recent weeks. I would soon be adding hammer taps and zaps and god knows what else to that list. And then there were the possible diagnoses, running from bursitis to Lyme’s disease to rheumatism to sclerosis. Somewhere in these ponderings, fleeting thoughts about how my daughter is doing wander in and out. While “taking it easy” for the past weeks,

I often listened in on my daughter’s tutoring sessions with her father, who had taught the subject himself for years. As is common when parents try to teach their own children, those sessions could become pedagogically questionable tests of endurance for both of them.

10:00 am. I enter the doctor’s office and am immediately sent on into an examination room – no waiting at all. The neurologist is sitting at his desk, puzzling over my various lab results. He openly admits that he doesn’t understand why my regular doctor sent me here. There is no sign anywhere of serious health issues. But he would do a quick test anyway, if for no other reason than to rule out neurological problems he already knows aren’t there. He proceeds to attach electrodes to various spots on my ankles and lower legs and then send little jolts of electricity through my body. It is a creepy feeling each time, but as with many things, the expectation of each zap is worse than the thing itself. The memory of the sensations fades quickly.

At the same time my daughter is getting pelleted with questions from a panel of teachers and supervisors in her exam. She would tell me later that she was incredibly nervous and could not even remember what the questions were.

When my own test is over, I pepper the doctor with a bunch of questions about various flags on my lab results and what, if any, he thinks my next steps should be. What further examinations should I undergo? Basically none. Why two such bouts of bursitis in two different joints in such a short time? Coincidence. What can I do to prevent further attacks? Not much. It is probably just normal wear and tear and a bit of bad luck. So there may be more of these little endurance tests in my future. Or not.

11:01 am. I decide to stop at the car wash on my way home. While waiting, I start texting my daughter to ask how the exam went. Three words into the message, my cell rings

and it is her. She is done and she isn’t sure how it went, but her favorite teacher gave her a little thumbs-up signal as she was leaving and she thinks she answered every question and she said everything she knew and she hoped it was enough and now she just has to wait one more hour for the results . . .

I tell her to call me as soon as she knows. I then drive home and proceed to stand confusedly in my kitchen for a while. I have nothing to do. Then it hits me that I haven’t swallowed any pain pills yet today. I decide to stop taking the medication altogether and see how it goes.

12:48 pm. My cell rings and

my daughter informs me that she got an “A” on her exam. Her last hurdle has been mastered. (She still has one more exam in English on Monday, but everyone knows she will sail through that one.) It’s now official: High school is over and her life can begin.

So here’s a possibly original take on the classic “why I haven’t been posting lately” post: I have just been so busy with one getaway after another.

First there was the sick leave, which, if I am honest, (and now that the memory of pain has faded), was really kind of nice. I have several crocheted animals to show for it.

That lasted about a week until boredom set in and sent me back to normal work for a few days. The week after was spent with two colleagues and twenty kids between the ages of 10 and 15 in an unheated house on an icy lake in Carinthia. Crap weather kept a lot of us in the one warm dining hall / arts and crafts / common room for most of the time. I taught a lot of kids to crochet and carve hiking sticks and make juggling balls with rice and balloons while my two coworkers took care of sports activities, homesickness and conflicts. We shared the task of kicking boys out of girls’ rooms and vice versa in the nights.

Back home, there followed an abnormally over-excited week of work, thanks to the fact that the sex education experts were coming on Thursday and half the school kids were in a permanent tizzy – until the workshop was over, that is. Thursday at 12:30 pm they all casually emerged from their daylong sequestration in a state of feigned blasé whateverness.

(Note to future self: schedule the sex workshop BEFORE the trip to Carinthia!)

The following weekend – last weekend – was spent with my husband in some long overdue twosomeness at a nearby spa – my birthday gift to him. It was really perfect timing. With a long work slog just behind him and a mammoth one coming up, this was his one chance to unwind and unplug for a few days. Experience has taught us that we don’t see much of one another in the last weeks of the school year. For us teachers, June is the cruelest month.

Upon arrival at the spa, the first realization was that he had forgotten to pack swimming trunks. He rejected my idea to simply buy new ones. He didn’t really want to spend time in the water anyway, he said. He would start his training for an upcoming mountain bike tour and take long runs instead. He checked his cell phone and email.

“Whatever you want,” I said, and secretly hoping that the spa would work its magic.

It did. By Day Three he was napping on a lounge chair by the pool.

June could now begin.

Back home again, I stared at my calendar for the upcoming month and became confused. It slowly dawned on me that – at least in my case – this year was as good as over. First off, three long holiday weekends all fall in June this year, so I only had 10 more school days – and those were mostly excursions and sports days and special projects. Written into my calendar were some concerts and fests, a recital, one play and a canoe trip. There was a day at the public pool. There was a high school graduation ceremony and a big family celebration. There was the last day of school and the sentimental ritual that includes.

June was going to be a breeze!! Or so I thought.

The way I see it, Life is not a pathway forward but a curve-filled trek, always spiraling back toward some earlier point in time, though maybe on a higher or lower plane. That idea is behind the name “circumstance” and the way my blog entries often tend to end at or near the place they started.

In the case of this post . . . I am back on sick leave. Whatever caused my hip problem (which is much better now) has wandered up to my left shoulder. I’m back on anti-inflammatory meds and have new specialists and tests ahead of me next week. I assume there are also some hefty antibiotics in my future and some physical therapy. Olga will probably be beating me up again.

I was just standing in the kitchen Saturday evening and talking to my daughter when a fairly intense pain suddenly flared up in my left hip. It came out of the blue and was strong enough to make the trip up the stairs a bit of a struggle. I muttered to myself, once again, about how it sucks to be growing older and hoped a good night’s sleep would take care of it.

On Sunday, I could barely walk.

Having gone through something similar with my shoulder a few years back, I self-medicated with some expired anti-inflammatory pills, checked my doctor’s office hours for Monday, and then called my boss with the potentially, probably, bad news. With three of my colleagues away as it is, my absence meant a lot of scrambling and improvising for the few remaining teachers. But then, what else can be done? As my boss said to me when she called back later, my only job for the moment was to take care of myself. Health comes first.

Sunday night, in bed, my condition reached peak pain. It got so bad that I actually panted. At 2 am, I stumble-schlepped myself to the bathroom and back, took another pain pill ahead of schedule and then somehow managed to fall into a shallow sleep.

I had to wait till 1 pm on Monday to see my doctor. When she heard I was having yet another one of these inflamed joint bouts, she announced that she was going on a mission to get to the bottom of it. Over the next four hours I was pricked with needles three times, I gave up a substantial percentage of my blood supply, and I peed on demand. I also posed (almost) nude for hip and lung x-rays. I allowed Vaseline to be smeared on me repeatedly for thyroid, hip and breast ultrasounds. I was shanghaied into my very first mammogram. Finally, I was also informed that I am officially on sick leave until my doctor informs me otherwise. I was ordered to come back on Thursday with another urine sample and to take it very easy in the meantime.

Strangely enough, I came home feeling much better.

Two of my thoughts since have been that 1) a person in pain will do pretty much anything a doctor tells them to and 2) the Austrian health care system is something of a miracle.

Take the mammogram part, for example. That’s a procedure I have been successfully avoiding for decades, despite the reminders I get biannually from my insurer. But today, when the doctor’s receptionist swiped my insurance card, a notice popped up in her computer that I was eligible for the examination at no cost. She asked me if I wanted to get that over with too while I was there. It would only take an extra five minutes. Of course I said no, but my husband, who was there with me, intervened and said I should just do it. I was trapped. Whoever designed this breast cancer prevention program knew what they were doing – how to reach the resisters and rope in the unwilling.

Now, of course, I am happy that the long war within me was ended by this surprise attack.

My own doctor’s reaction to my condition also fits right in with the design of the system as a whole. One of the policies intentionally tries to maintain enough general practitioners and to distribute them around the country where needed. My doctor knows me well by now and she admitted that she was taking full advantage of my visit to check everything she wanted – because she knew it might be years before I showed up again. She ordered all the tests and examinations; she made sure I got them done right away at the nearby health center in the brand new, state-of-the-art radiology office. And because she ordered them, everything was covered. All the results will be sent back to her and she will decide on my treatment, if any, with a complete picture from all the various experts at her disposal.

Back at home, I started googling about the costs of all these tests in the States. Of course the information was all very complicated depending on where you live, whether and how you are insured and how much your co-pays are, but it was pretty clear that those four hours of tests could have set me back as much as $2000 dollars. In contrast, all I had to pay for that Monday was the prescription fees: a grand total of $9.

Maybe the greatest miracle of the health system here are the thoughts that never crossed my mind as I headed toward the doctor’s office in pain. Can I afford this? Can I afford to take a day off of work? What a gift it is that for everyone – and I mean everyone – such factors don’t even make it into the equation.

Twice a day, I walk Dog Four around the cornfield. I have even blogged about it, seeing as how it is a non-negotiable part of my everyday life (“What the Doctor Ordered”). About halfway along this route there is a “No Trespassing” that has annoyed me for three decades. One of the lovely things about the area I live is that all the fields and forests are legally accessible to everyone. The only fences around are to contain herds of cattle and they are mostly temporary. I like the openness of area.

So that yellow sign is an affront. Luckily it is on a chain which hangs so low that I can easily step right over it.

Beyond the sign is a beautiful and peaceful meadow completely surrounded by trees. There are some beekeeper boxes and an old deer feeder which looks slightly more slanted every year. One of these days it is going to topple, just like the hunter’s perch that used to be near it. A really bad storm took it out a few years back. It was nice to look at, but considering its purpose, I am kind of glad it is gone. There is also a sort of bench.

I often extend my dog walks by circling the edge of the meadow. I like to sit down on the bench, look out over the grass and trees, the rolling hills and mountains behind them, and think about stuff. Not problems or concerns, just random pleasant stuff. This is not a place for hamster wheel brooding. It’s a quiet, peaceful, flowery place, equidistant and at the other end of the world from my workplace hassles, the toilet brush and the daily pwesidential news onslaughts. It’s a place where for ten minutes a day, I can be unplugged and un-assailed. I can also be completely alone. Thanks, in part, to that yellow sign.